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Presented by Tammara Moore, PT, ART, Laurie Barnum, PT, ART and Albert Salopek, ATC
Swimming, biking and running place considerable stress on the body and many athletes suffer a broad range of injuries. Many of these are caused by overuse. The most common injuries we see are those related to cumulative trauma. These can include: back or hip pain, knee tendinitis, shin splints, plantar fascitis, iliotibial band syndrome, neck pain, swimmer’s shoulder/impingement.
How do overuse injuries occur? Usually an injury will occur due to an overuse of a muscle or other traumatized soft tissues such as a tendon. This can be caused by: inadequate rest or overtraining; muscular imbalances, not allowing for proper recovery, poor flexibility, weakness and/or improper shoes or bike fitting.
- More injuries occur with running than swimming or cycling, and this can be due to the increased forces in the body of over 4-5 times skeletal shock to the joints as opposed to walking.
- Injuries can occur from acute injuries, cumulative small tears such as microtrauma, or reduced oxygen to cells which is called hypoxia.
The Cumulative Injury Cycle
The cumulative injury cycle can occur with repetitive effort. With fatigue, increased pressure, tension or friction can occur in the tissues. The body will lay down tough scar tissue to repair the area. This is the body’s attempt to stabilize an overworked area. This can result in fibrous adhesions in muscles or soft tissues in the body. As a result, muscles become shorter and weaker, and may not able to transmit effective power or “give” like we ask them to function in our athletic activities.
Trapped nerves may not transmit signals and prolonged friction, pressure or tension can result in inflammation. This can over time reduce range of motion in structures, and lead to a loss of strength in the area. Tingling, numbness and weakness can also occur and increased pain signals are a result of this cycle.
What are the most common causes of injuries?
1. Overtraining
2. Not allowing for proper recovery
3. Muscular imbalances
4. Biomechanical faults. Asymmetrical movement, along the kinetic chain which can include improper flexibility at the foot, hip, knee, ankle, spine and all the way up to the neck and shoulder.
5. Joint restrictions
6. Muscle restrictions
7. Poor core strength and/or flexibility
8. Poor balance, neuromuscular control and proprioception
Fourteen Tips to Prevent Injury:
1. Listen to your body:
Allow for recovery, particularly if one feels irritable, possesses low motivation, or has an inability to get the heart rate up in the workout and a feeling of tiredness, moodiness, disruptive sleep patterns.
Test the morning heart rate; if it is 10 beats higher, there is a good chance that your body is in need of serious recovery. It is good to take some needed rest.
2. Avoid overtraining. Studies show that the best injury predictor may be the amount of training you completed last month. It is well known that fatigued muscles cannot protect associated connective tissue structures, and this increases the risk of damage to bone, cartilage, tendon and ligament. Total mileage for running is an excellent indicator of your injury risk. A good rule of thumb is not to increase your mileage over 10% a week. Recovery time reduces injury rate by giving muscles and connective tissues an opportunity to repair.
3. Get regular massage, particularly during your buildup phase, and during recovery. No longer are massages just to “feel good”. I find that massage helps tremendously to release muscle restrictions, improve blood flow, remove lactic acid, relax the nervous system, and improve one’s recovery after training. It is essential to incorporate into an athletes’ program and should be a part of ones’ body maintenance schedule.
4. Strengthen weakened muscles. Many athletes who have been sedentary and start to exercise more vigorously may have problems that pop up due to some underlying weakness or muscular imbalances. It is extremely wise to couple resistive training with swimming, biking and running. Increasing training should correspond with an increased effort for stretching and strengthening.
5. Allow plenty of time for proper warm-up and cooling off and stretching after your workout, while the muscles are still warm.
6. Replacing shoes after 400-500 miles and using adequate shoes for your type of arch. For example, a hyperpronator needs a more stable heel counter or a motion control shoe, whereas someone with a high arch may tend to supinate more and may not need an extremely rigid shoe. It’s good to try many shoes in order to get a good fit and run in them in the running store before you buy them.
7. Treat even minor injuries with the RICE principle: rest, ice, compression and elevation. Do not train when experiencing pain, which can lead to further injuries and other compensations. It’s important not to train hard when you are stiff or have muscle soreness from the previous effort. The next effort should be easy.
8. Muscular imbalances can result in the repetitive motions of swimming, cycling and running and the poor postures associated with being in the bike position. Motion in these sports occurs primarily in the sagittal plane (forward motion). As a result, many athletes may develop tightness of their rotatore muscles and those that allow side-bending and rotation of the spine. Another underlying cause of injuries is inadequate motion in the hips and pelvis. Exercises that improve rotation and sidebending are important exercises for the triathlete ...”use it or lose it”!
9. Strength of the core is essential for transmitting forces in the body. The core of the body is where you derive power. It provides the foundation for all arm and leg movements. Body movement is a complex event with agonist-antagonist structures working together in synergy to provide strength, stability and motion while at the same time the body is also able to stabilize in all three directional planes of motion. This is essential for optimal performance, symmetry and fluidity in the athlete. Core muscles are comprised of the multifidus, the interspinalis, intertransversii, rotatores, abdominals, transverse abdominus, internal/external obliques, erector spinae, and quadratus lumborum thoracolumbar fascia. It’s important to remember that the body has a kinetic chain with relation to all its parts and these relationships affect one another. It is therefore common to see an athlete who complains of foot pain that may actually have a problem with spinal rotation or hip weakness that is contributing to an overuse of the foot structures. This is just one example.
10. Exercises can go a long way in preventing these imbalances from resulting in an injury. It is important to perform a daily stretching program and incorporate strength, training and core stability exercises into a triathlete’s training program.
In summary, stretching maintains flexibility and will avoid the cumulative muscle shortening that can occur with repetitive activity.
11. What to do if a musculoskeletal injury occurs:
Rest, stop further activity and apply ice. It is known that ice can reduce inflammation and swelling, speeding healing time, and also this would be used particularly after a hard workout if soreness shows up. Elevation and compression can help with swelling. Seek care if the pain persists more than a few days.
Triathlon fitness and good running takes months and years to develop. Emphasizing consistency and patience is key. If you are new to this sport, build up gradually and learn proper techniques in all disciplines.
If you are having pain: See a physical therapist or medical provider who works with triathletes. Get a biomechanical analysis. If you are having any residual pain during or after a workout, seek medical care with a practitioner that understands these types of injury from a prevention standpoint. A full evaluation of your problem can avoid further injury and return more quickly to activity. I have found that Active Release Techniques® to be an effective treatment for most musculoskeletal injuries coupled with appropriate and specific rehab exercises and can return the athlete quicker to full activity and improve performance by improving the body’s efficiency.
12. Cycling: Bike fit is crucial to optimum function and to avoid injury. I suggest a proper bike fit with a professional who understands triathletes’ needs.
13. Running: Follow the 10% rule. Increase weekly mileage no more than 10%, and after 3 weeks there should be a decrease in one’s mileage to allow for proper recovery. We’ve already talked about maintaining proper running shoes and replacing when worn. Try to run on soft terrain or trails to decrease skeletal shock and pounding stress to the joints.
14. Last but not least, have fun! Enjoy a balanced perspective on training.
A Few Common Biomechanical Faults with Running:
1. “Foot caves in” (dropped navicular or arch)
Weakness of posterior tibialis, foot intrinsics, anterior tibialis, tight gastrocnemius or soleus
2. Poor knee control, knee “caves in”:
Poor stability of gluteus medius in the hip, poor quadriceps control
3. Anterior pelvic alignment
Limited hip extension usually a tight psoas; poor core stability
4. “Forward flexed trunk”
Tight psoas, rectus femoris, abdominal shortening (rectus)
5. Asymmetrical arm swing
Many causes, can include poor trunk rotation; tightness of transverso-spinalis, multifidi; core or scapular weakness; upper trapezius tightness
6. Asymmetrical shift or transfer of weight
Lumbopelvic/ hip weakness or stability and/or muscular tightness
7. Shortened stride and posterior tilt of the pelvis: shortened hamstrings
A biomechanical assessment that includes functional joint/muscle testing can help evaluate your weak links. We, at SOLPT, offer digital video analysis to identify and design a customized rehab or performance program to optimize your running efficiency.
Sports Specific Exercises for Triathletes
1. Lie on back with strap hooked around foot.
2. Keeping knee straight and back in neutral, pull leg up until you feel a light stretch on the back of the leg.
3. 3 Sets x 30 second holds.
1. Lie on back with strap hooked around foot.
2. Keeping knee straight and back in neutral, pull leg up and out until you feel a light stretch on the inside part of the leg.
3. 3 Sets x 30 second holds.
1. Lie on back with ankle resting on opposite knee.
2. Keeping back in neutral, grasp behind knee and pull leg towards chest until you feel a light stretch in your gluteal area.
3. 3 Sets x 30 second holds.
1. Lie on back with both knees bent.
2. With one hand grasp behind knee and with the other hand grasp behind ankle.
3. Gently pull your shin so your knee comes up towards opposite shoulder.
4. 3 Sets x 30 second holds.
1. Lie on stomach with strap hooked around foot.
2. Keeping back and neck in neutral, pull foot towards buttock until you feel a light stretch in the front part of the leg.
3. 3 Sets x 30 second holds.
1. Lie on your side with hip resting on top of roller and body supported with your elbow and opposite foot.
2. Keeping neck and back in neutral, gently roll On the outside part of the thigh between the hip and knee.
3. 1 Set x 1-2 Minutes.
1. Lie on your back with a roller underneath your hips.
2. Grasp behind one knee and gently pull knee toward your chest until you feel a light stretch on the opposite hip flexor.
3. 3 Sets x 30 second holds.
1. Lie on back with a roller underneath your shoulders and both knees bent.
2. Keeping belly button sucked in towards your spine, lift hips off the ground so your spine is parallel to the floor.
3. Gently roll back and forth so the roller covers the length of you shoulder blade.
4. 1 Set x 1-2 Minutes.
1. Standing with your knees straight and the balls of your feet resting on the edge of something (stair, half roller, curb etc.).
2. Gently feel a light stretch on back part of the calf.
3. 3 Sets x 30 second holds.
4. Repeat same stretch with knees bent.
1. Lie on your back with spine resting on top of a roller. Make sure head is supported on the roller.
2. Gently allow arms to lay to the side over the roller as if making a ‘T’ with your arms.
3. 1 Set x 1-2 Minutes.
1. Lie on your side with arms resting on top of each other.
2. Rotate through your spine and move your top hand back as if stringing a bow.
3. 3 Sets x 30 second holds.
1. Seating up straight with one leg outstretched and the other leg bent so your ankle is behind opposite knee.
2. Rotate through your lumbar spine toward the bent knee side and rest elbow on opposite knee.
3. 3 Sets x 30 second holds.
1. Sitting up straight with hands behind your back, grasp each forearm with opposite hand.
2. Gently side bend your head to one side until you feel a light stretch on the side of your neck.
3. 3 Sets x 30 second holds.
1. Sitting up straight, grasp your elbow and pull arm across your chest. Make sure to keep both shoulders from elevating.
2. Gently side bend your head to the opposite side until you feel a light stretch on the posterior portion of the shoulder and shoulder blade area.
3. 3 Sets x 30 second holds.
1. Standing up straight, balance on single leg.
2. To challenge yourself, stand on various surfaces (pillows, rolled up blankets etc.) or close your eyes.
3. 3 Sets x 1 Minute balance time.
1. Standing with your knees straight and the balls of your feet resting on the edge of something (stair, half roller, curb etc.).
2. Gently lift your heels off the ground and rise up onto the balls of your feet.
3. Slowly transfer onto a single leg and lower yourself back down with total control and no wobbling.
4. 3 Sets x 15 Reps.
1. Place Thera-band around ankles and stand in a mini squat position.
2. Gently side step paying special attention towards not hiking up your hip or rocking your body back and forth like a weeble wobble.
3. 3 Sets x 15 Reps
1. Standing with feet about shoulder width apart.
2. Keeping neck and back in neutral, hinge at the hip and bend at the knee.
3. Make sure knees do not move out past your toes or let your knees buckle in towards each other.
4. 3 Sets x 15 Reps.
1. Lie on your side with upper body supported on your elbow. Make sure your entire body is perfectly straight as if you were standing.
2. Suck your belly button towards your spine and lift your hips off the ground. Keep you neck and back in neutral.
3. 3 Sets x Fatigue.
1. Kneeling on the ground with elbows supported on a Fit-Ball with neck and back in neutral.
2. Slowly roll the ball out so the shoulders and hips both move as one unit. Keeping your neck and back in neutral.
3. Move out as far as you can without loosing neutral position.
4. 3 Sets x Fatigue.